Evaluating pain management strategies following hypospadias repair: a survey of pediatric urologists

Background: Pediatric opioid use has been associated with serious adverse effects, including persistent use and overdose. Recent studies have shown that opioid needs may be minimal following outpatient pediatric urologic surgery. Post-operative pain regimens following pediatric penile surgery are not standardized. This study aimed to identify current opioid prescribing practices following hypospadias repair. Methods: An online survey was administered to members of the Societies for Pediatric Urology, including eight questions surrounding physician demographics, hypospadias repair case volume, attitudes regarding opioid prescription in pediatric urology, and post-operative pain regimens. Responses were stratified for analysis. Results: A total of 88 of 350 members responded to the survey, achieving a response rate of 25%. Most respondents practiced in an academic setting (73%) and had a case volume between 0–50 hypospadias repairs annually (76%). Only 26% of respondents reported using a standardized post-operative pain regimen following hypospadias repair. Respondents with higher case volumes were less likely to prescribe opioids. Following hypospadias repair, 61% of respondents reported regularly prescribing opioids, while 58% felt opioids are overprescribed following pediatric urologic procedures. Conclusions: This study demonstrates wide variability in opioid prescribing patterns and attitudes among pediatric urologists. Despite growing evidence that opioids may not be necessary following pediatric urologic surgery, over half of pediatric urologists regularly prescribe opioids following hypospadias repair. Additionally, over half of the respondents believe opioids are over-prescribed. These findings represent an opportunity to improve opioid stewardship, which is meaningful given the ongoing opioid crisis. This demonstrates the need for evidence-based pain management guidelines following hypospadias repair.